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Passing responsibilities down to lower levels of government should be undertaken primarily to place services closer to the people being served and to maximize administrative

Policymakers should expand opportunities for people to volunteer in their communities. This includes older adults and people with disabilities.

Deficit-reduction efforts should avoid cuts in programs that serve low- and moderate-income populations. 

States should not tie essential spending programs to unstable revenue sources. 

The federal government must strive for long-term fiscal balance.

Federal policymakers should develop a comprehensive system for financing Long-Term Services and Supports (LTSS) that includes a new social insurance program to provide a basic level of LTSS.

Ideally, the federal government should finance LTSS through a universal, comprehensive, and publicly administered program such as Medicare or similar social insurance program of shared risk. 

States should require adequate numbers of appropriately trained staff to ensure a high quality of care.

Quality measures: Participant preferences and satisfaction should be used as key quality measures.

The federal government should assume a much stronger role in ensuring the quality of services paid for by Medicaid in residential care settings.